吻合指侧方静脉的指尖离断再植

目的 介绍指尖离断再植中重建静脉回流的一种新方法.方法 2008年3月-2011年12月,对40例46指指尖离断行再植时,采用吻合侧方静脉重建回流,吻合指侧方静脉数目共87条,吻合动脉数目共57条,每指平均吻合2条侧方静脉和1条动脉,术中吻合动静脉比例1∶1或1∶2或2∶2,平均1∶2.结果 所有病例全部成活,无1例发生回流障碍,指甲近乎完整,伤口均一期愈合.所有患者均获随访,随访时间6～24个月（平均14.5个月）,指尖外形、功能恢复满意,指体无明显萎缩,43指指甲生长近平整,3指指甲呈脊样生长,接合神经及神经植入的43指,感觉恢复4～6 mm平均5.2 mm.未接合神经的3指均恢复保护性感觉,指体各关节活动无影响.依据1975年美国手外科学会推荐手指总的主动活动度（TAM）系统评定方法评定：优43指,良3指,优良率100％.结论 吻合侧方静脉在指尖离断再植中重建回流是可行、正确的,是一种全新的理念,值得推广.

The replantation of amputated fingertip by finger latral vein neuroanastomosis

Objective To introduce a new method of reconstruction venous return in replantation of amputated fingertip. Methods From March 2008 to December 2011, 46 fingertips in 40 cases were involved in the study, reconstruction venous return with anastomosing finger latral venous, anastomosing 87 venous and 57 arteries in 40 cases （46 fingertips）, with an average of anastomosis 2 venous and 1 artery in 1 fingertip, the anastomotic rations of A：V were 1：1 or 1：2 or 2：2, averaged of 1：2. Results All fingertips survived completely, no finger happened venous return obstruction, the appearance of the nail was good, wounds at donor sites healed by first intention. All patients were followed up ranged from 6 to 24 months, with the mean of 14.5 months, the appearance and function recovered satisfactorily, that no significant atrophy, it growed smooth nails in 43 fingers, 3 nails showed that ridge-like growth, the sensory restored 4~6 mm （mean 5.2 mm） in 43 fingertips of combining nerve and nerve implantation. 3 fingertips of no combining get protective feeling, it means the body has no effect on the joints. According to the total active movement evaluation system （TAM system） introduced by the American Society for Surgery of the Hand in 1975, the results of this series were excellent in 43 fingers, good in 3 fingers, the excellent and good rate was 100%. Conclusion This is a new desirable method that using anastomosis finger latral venous in replantaion of amputated fingertip, it is worthy of clinical use.